Provider Demographics
NPI:1174075576
Name:GOODMAN, MAREA (LM, CPM)
Entity type:Individual
Prefix:
First Name:MAREA
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 OVERLAKE CT
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-1331
Mailing Address - Country:US
Mailing Address - Phone:831-241-8089
Mailing Address - Fax:510-255-6269
Practice Address - Street 1:11 OVERLAKE CT
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-1331
Practice Address - Country:US
Practice Address - Phone:831-241-8089
Practice Address - Fax:510-255-6269
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA444176B00000X
TX99235176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife